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Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.
A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. On exam, you see bright red blood trickling down her left tonsillar fossa.
A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.
In her spare time, Melissa also enjoys being the fellowship director to an amazing group of PEM trainees. Case: Brian is a 14-year-old male who presents to the emergency department (ED) complaining of acute onset testicular pain. He has vomited twice, but there is no history of any fever or trauma. AEM Dec 2017.
Children in the validation cohort were admitted to the intensive care unit or operatingroom less frequently than those in the derivation cohort. A proportion of participants were missed because the ED provider refused enrollment or said “Other,” but this is not well described. What is the problem? What were the results?
Takeaway lessons * Trauma patients who are hypotensive or otherwise unstable should be assumed to be bleeding, bleeding, bleeding until proven otherwise, and should have a very low threshold to proceed directly to the operatingroom for exploration.* Operative prep for exploratory laparotomy is usually from the chin to the knees.
A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. F, RR 16, SpO2 97% on room air. Vital signs include BP 90/48, HR 122, T 98.3
of patients with open long bone fractures receive antibiotics within the critical first 60 minutes of ED arrival. Surgical Repair of Hip Fractures: Demonstrating effective care prioritization, 94% of older adults with hip fractures were moved to the operatingroom within 24 hours.
Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)
IPPS Proposed Rule by the Centers for Medicare & Medicaid Services The Age-Friendly Hospital measure assesses hospital commitment to improving care for patients 65 years or older receiving services in the hospital, operatingroom, or emergency department (pg. This is a proposed measure, not to be set in place until Fall 2024.
The standard care in North America for post-traumatic EDH involves decompressive craniotomy or trepanation via a burr hole, typically performed in an operatingroom by neurosurgery teams. Initially refusing emergency medical services, she was brought to the ED via a private vehicle. What are the key takeaways? (1)
In 1901, UVA opened its first hospital with 25 beds and three operatingrooms. The emergency department (ED) at UVA was rebuilt in 2019 and the department had not fully optimized its operations when COVID-19 hit. Following the pandemic, the ED saw a surge in its volume as it raced through 60,000 to 80,000 visits per year.
A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. His vital signs were within normal limits except for a respiratory rate of 23 with a room air pulse oxygen in the upper 90s. Click to enlarge.)
A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Click to enlarge.)
Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. Paper: Owyang CG, et al. J Crit Care.
A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operatingroom videos, recovery tips, and patients praising their plastic surgeon. Or Helly Larson describing the first week after her Miami BBL as “absolute hell” to a Vox reporter.
1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. 4 Pain is the most common reason for presentation in the early post operative period. 10% of patients.
7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. 7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. He reports distension and the sensation of fullness. Small bowel dilation may also be seen.
C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚
One systematic review of 1283 patients showed that if you got to the operatingroom within 6 hours, you had a 97% chance of saving the testicle. The gold standard – the only way you will really know if there is a torsion or not – is to take a look in the operating theatre. How do you diagnose torsion?
Case A 40-year-old female at 11 weeks, five days gestation presented to the emergency department (ED) with concern for lower abdominal pressure and inability to fully empty her bladder. The patient was admitted to the obstetrics service and underwent spinal anesthesia in the operatingroom to manually reduce the uterus.
3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. 3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. 5 Untreated, nearly all patients die.
Diagnosis is clinical and challenged by overlap with more superficial skin infections (i.e. cellulitis) and the need for thorough examination of the genital region. 1 His description of cases of life-threatening infections in the perineal, genital or perianal regions were thought to be idiopathic in previously healthy men.
Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the OperatingRoom: A Cluster Randomized Clinical Trial. Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. 2024 Mar 18:e240762. doi: 10.1001/jama.2024.0762.
Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operatingroom). Randomized controlled trials or comparative non-randomized observational studies. airway scope).
Anterior dislocations: palpation of the TMJ can reveal one or both of the condyles to be anteriorly displaced in front of the articular eminence. Louis, Mosby, Inc., 2010, (Ch) 70: p 895-909.
While this guide isnt exhaustive, its designed by residents, for residents, to provide practical tips and foundational knowledge thats crucial in the fast-paced, high-stakes environment of the ED. Introduction Airway management is a critical ED skill to master. fiber optic through the nose).
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